Guidelines for Complications of Cancer Treatment Vol VIII Part B

Preoperative Preparation of the Patient Patient preparation for perioperative pain managementshould include appropriate adjustments or continuationof medications to avert an abstinence syndrome,treatment of preexistent pain, or preoperative initiationof therapy for postoperative pain management(Insufficient evidence).58Anesthesiologists offering perioperative analgesiaservices should provide, in collaboration with others asappropriate, patient and family education regarding theirimportant roles in achieving comfort, reporting pain, andin proper use of the recommended analgesic methods(Supportive evidence).Perioperative Techniques for Pain ManagementThe Task Force supports the use of epidural, PCA, and regionaltechniques including but not limited to intercostals blocks,plexus blocks, and local anesthetic infiltration of incisions byanesthesiologists when appropriate and feasible Anesthesiologists who manage perioperative pain shouldutilize therapeutic options such as epidural or intrathecalopioids, systemic opioid PCA, and regional techniques,after thoughtfully considering the risks and benefits forthe individual patient. These modalities should be usedin preference to intramuscular opioids ordered “asneeded.” The therapy selected should reflect theindividual anesthesiologist’s expertise, as well as thecapacity for safe application of the modality in eachpractice setting. This capacity includes the ability torecognize and treat adverse effects that emerge afterinitiation of therapy (Supportive evidence)Special caution should be taken when continuousinfusion modalities are used, as drug accumulation maycontribute to adverse events. (Insufficient evidence)